Respiratory Pharm Flashcards
What are the first generation H1 blockers?
-en/-ine or en/ate
Diphenhydramine
Dimenhydrinate
Chlorpheniramine
What are the uses of H1 antagonist?
Allergy
Motion sickness
Sleep aid
What are the side effects of H1 antagonists?
Sedation
Antimuscarinics (constipation; contra in Alzheimer’s)
Anti-alpha- adrenergic (vasodilation)
What are the second gen H1 blockers?
-Adines Loratidine Fexofenadine Desloratadine Cetirizine
What are second gen used for?
Allergy
What is the advantage of second gen h1 antagonists?
Far less sedating than 1st gen because less entry into CNS (does not cross BBB)
What are the drugs for prophylaxis of asthma?
Salmeterol
Formoterol
They are long acting beta-2 agonists
What are the side effects of the long acting beta-2 agonists?
Tremor
Arrhythmia
What is theophylline?
A methylxanthine
Phosphodiesterase inhibitor –> perpetuates cAMP action
Blocks adenosine
Causes bronchodilation
What are the side effects of theophylline?
Cardiotoxicity
Neurotoxicity
Metabolized by P450 so increased by P450 inhibitors (macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir, alcohol, cipro, ketoconazole, sulfonamides, gemfibrozil, quinidine)
this is a problem because theophylline has a low TI
blocks adenosine action
What muscarinic antagonist is used for preventing bronchoconstriction, COPD?
Ipratropium and tiotropium
What are the corticosteroids used for asthma?
Beclomethasone
Fluticasone
*1st line tx in chronic asthma
What is the MOA of beclomethasone in asthma?
Inhibits the synthesis of all cytokines
Inactivates Nf-kb (inducer of transcription of TNF-a)
anti-inflammatory agents
What are the anti leukotrienes?
Montelukast
Zafirlukast
Zileuton
What are the anti leukotrienes used for?
Aspirin-induced asthma
See nasal polyps
What is the MOA of zileuton?
5-lipoxygenaas pathway inhibitor
Blocks the conversion of arachnidonic acid to leukotrienes
What is omalizumab?
Monoclonal anti-IgE antibody
What is omalizumab used for?
Allergic asthma that is resistant to inhaled steroids and long acting b2 agonists
What are guaifenisin and n-acetylcysteine?
Expectorants
They thin respiratory secretions and loosen mucus plugs
Does not suppress cough reflex
What is n-acetylcysteine used for?
A mucolytic for CF patients
Antidote for acetaminophen OD
What is the MOA of bosentan?
Competitive antagonist of endothelin-1 receptors so decreased pulmonary vascular resistance
What is bosentan used for?
Pulmonary Arterial HTN
What is dextromethorphan?
Antitussive
Synthetic codeine analog that antagonizes NMDA glutamate receptors.
What are pseudophedrine and phenylephrine used for?
Nasal decongestant
Reduce hyperemia, edema, nasal congestion
Open obstructed Eustachian tubes
What are the side effects?
HTN Anxiety (pseudophedrine = CNS stimulant)
What are some of the contraindications to first gen H1 antagonists?
Older
Vision problems
Gait disturbances
What is methacholine?
A muscarinic receptor agonist
Used in asthma challenge test
What is the MOA of ipratropium?
Blocks M3 receptors in the airway smooth muscle and sub mucosal glands. (m3 works through the Gq pathway with phospholipase C and IP3/DAG)
Offers short term relief of asthma
What is flunisolide?
A glucocorticoid used for asthma
What is the most common side effect of inhaled glucocorticoids?
Oropharyngeal candidiasis
What is the MOA of cromolyn and nedocromil?
Inhibits mast cell degranulation
What are cromolyn and nedocromil used for?
Prophylaxis of acute attacks of asthma
What are the actions of leukotrienes?
Vasoconstriction Bronchoconstriction Increased vascular permeability Mucosal edema Mucus hypersecretion
How do you treat Methemoglobinemia?
Methylene blue
How do you treat cyanide poisoning?
Nitrites
Thiosulfate
(Nitrates oxidize Hb to methemoglobin to bind cyanide and remove from cytochrome oxidase– allowing it to function)
(Thiosulfate binds the cyanide bound to methemoglobin forming thiocyanate which is renally excreted)
How do you treat CO poisoning?
100% O2
Hyperbaric O2
How do you treat altitude sickness?
Acetazolamide (carbonic anhydrase inhibitor)
increases renal excretion of bicarb to compensate for respiratory alkalosis in high altitudes
How do you treat RDS (neonatal)?
Maternal steroids prior to birth
Neonatal artificial surfactant
*NO supplemental O2
How do you treat ARDS (adult)?
Pure O2
What is the MOA of Albuterol?
Short-acting Beta-2 agonist
relaxes bronchial smooth muscle
When do you use Albuterol?
Acute exacerbation of asthma
What is the risk in using Dextromethorphan?
Mild opioid effect in excess = mild abuse potential
Antidote for OD: Naloxone
What is the MOA of n-acetylcysteine
Mucolytic agent that cleaves intermolecular disulfide bonds within mucus glycoproteins
